Provider Demographics
NPI:1114969755
Name:HARLAN EMERGENCY MEDICAL SERVICES CORPORATION
Entity Type:Organization
Organization Name:HARLAN EMERGENCY MEDICAL SERVICES CORPORATION
Other - Org Name:HARLAN EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-573-2721
Mailing Address - Street 1:PO BOX 169
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:KY
Mailing Address - Zip Code:40831
Mailing Address - Country:US
Mailing Address - Phone:606-573-2705
Mailing Address - Fax:606-573-9777
Practice Address - Street 1:151 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:KY
Practice Address - Zip Code:40831-7275
Practice Address - Country:US
Practice Address - Phone:606-573-2705
Practice Address - Fax:606-573-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY13033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00163744OtherRAILROAD MEDICARE
KY000000352805OtherBLUE CROSS BLUE SHIELD
KY56027832Medicaid
KY08062400OtherBLACK LUNG
KY1088073OtherPASSPORT HEALTH
KY55001127Medicaid
KY000000352805OtherBLUE CROSS BLUE SHIELD
KY55001127Medicaid